Ramadan is among the five major pillars of Islam, during which adults abstain from eating and drinking from dawn to sunset. Some individuals with diabetes mellitus are exempt from fasting due to potential health risks. However, many choose to fast. We investigated Ramadan fasting practices, lifestyle factors, sleep patterns, and fasting-related risk among patients with diabetes and those without diabetes. This cross-sectional study was conducted among 204 participants with and without diabetes in Tabuk, Saudi Arabia, from March to April 2025. A structured questionnaire evaluating demographic factors, the International Diabetes Federation risk score (IDFRS) for fasting risk, sleep patterns, and exercise was used. Among the 204 participants, 65.7% were women, the mean age was 33.69±11.94 years, 25.5% had diabetes, and 59.8% reported sleeping <6 hours per night during Ramadan. Among participants with diabetes, 65.4% reported hypoglycemia, 15.4% reported hospital admission during Ramadan, and 73.2% were classified as having moderate/high fasting risk according to the IDFRS. Participants with diabetes were older than those without diabetes (38.2±15.2 vs. 32.5±10.3 years, p=0.034). Multivariable logistic regression assessing factors associated with fasting showed that older age (adjusted OR 0.93, 95% CI 0.87–0.99; p=0.034) and obesity (adjusted odds ratio 0.19, 95% confidence interval 0.04-0.95; p=0.043) were associated with lower odds of Ramadan fasting. Individuals with diabetes experienced fasting-related risks, including hypoglycemia and hospital admission. These findings highlight the importance of individualized assessment, education, and risk-based guidance for people with diabetes who choose to fast during Ramadan.
Dear Editor, While common adverse events associated with sodium-glucose cotransporter-2 inhibitors—such as genitourinary infections and volume depletion—are well-characterized, rare immune-mediated cutaneous manifestations are increasingly recognized in post-marketing surveillance...
Listeria monocytogenes is a gram-positive bacillus that can cause a wide spectrum of clinical manifestations, ranging from paucisymptomatic to life-threatening disease. Central nervous system involvement is called neurolisteriosis and is a rare and severe entity that includes meningitis, meningoencephalitis, rhombencefalitis, and brain abscess, and it may start with a stroke-like presentation. People with rheumatic diseases taking immunosuppressive medications are at increased risk, and they also can have atypical presentations, misleading the diagnosis of infection. Magnetic resonance imaging can guide the diagnosis; however, a high clinical suspicion and a microbiological confirmation are needed. Here we present a case of Listeria monocytogenes brain abscess mimicking an ischemic stroke that occurred in a male patient with a previous diagnosis of polymyalgia rheumatica under immunosuppressive treatment. A literature revision was also performed.
The neutrophil-to-lymphocyte ratio (NLR) has emerged as a simple, cost-effective biomarker of systemic inflammation in various respiratory diseases. However, its association with bronchiectasis severity in patients with post-tuberculosis bronchiectasis remains limited. This study aimed to investigate the association between NLR and bronchiectasis severity as assessed by the FACED classification and to identify factors contributing to disease severity in patients with post-tuberculosis bronchiectasis. This retrospective cross-sectional study involved 49 patients with post-tuberculosis bronchiectasis. Bronchiectasis severity was assessed using the FACED score. NLR was calculated from routine complete blood counts. The Mann-Whitney U test compared NLR between mild and moderate severity groups, and factors associated with moderate severity were also analyzed. The median NLR was significantly higher in patients with moderate bronchiectasis compared to those with mild disease (7.16 vs. 3.25, p=0.043), driven primarily by significantly lower lymphocyte percentage in the moderate group (11.20 vs. 22.05, p=0.043). Moderate severity was significantly associated with forced expiratory volume in 1 second <50% predicted (p<0.001), radiological extension involving more than two lobes (p=0.010), and a modified Medical Research Council dyspnea score ≥2 (p=0.049). No significant associations were observed for age, sex, comorbidities, smoking status, or Pseudomonas colonization. Taken together, NLR is significantly elevated in patients with moderate bronchiectasis compared to those with mild disease, primarily reflecting relative reduced lymphocyte percentage in more severe disease. As an easily obtainable, inexpensive biomarker, NLR may serve as a practical tool for initial risk stratification in post-tuberculosis bronchiectasis, particularly in resource-limited settings.
Dear Editor, Congenital anomalies of the kidney and urinary tract are increasingly recognized in adulthood, frequently as incidental findings during imaging performed for unrelated indications...
